YTC-30280-60681
2 vaccinations
7 coded responses
8 check-ins
7 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 301 / GA
- Registered
- 2021-03-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-28
Dose 1 — Moderna
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2021-02-26
Dose 2 — Moderna
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2021-03-09
Registered in v-safe
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2021-03-09
Survey response — day 7, dose 2MedDRA: Herpes zoster, Sensitive skin — Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Systemic reaction (other): Shingles · Healthcare visit (other): Sensitive skin diagnosis shinglesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-09
Report sent to call center — day 7, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-03-12
Survey response — day 14, dose 2MedDRA: Breast swelling, Flank pain, Herpes zoster — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Pain in left side and swollen breast. Shingles have spreadMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-19
Survey response — day 21, dose 2MedDRA: Abdominal discomfort, Abdominal pain, Axillary pain, Chest pain, Hypoaesthesia, Oedema peripheral — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Left chest and under arm swelling and painful. Left side of stomach heavy or numb feeling. Painful to drive my car or hit bumps in road. Have to hold my left side to do anythingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-27
Survey response — day 28, dose 2MedDRA: Abdominal pain upper, Chest pain, Hospitalisation — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Hospitalized for blood clots in leg and chest. Hospitalized given intravenously with blood thinners. Home with blood thinners, still having pain in chest and stomach areaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-27
Report sent to call center — day 28, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-04
Survey response — day 35, dose 2MedDRA: Dyspnoea, Emergency care, Hospitalisation, Pyrexia, Thrombosis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: High fever 103, struggling to breathe, took to ER where they found 3 blood clots admitted to hospital (b)(6) Medical Center, put on blood thinners and oxygenMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-04
Report sent to call center — day 35, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-09
Survey response — day 42, dose 2MedDRA: Herpes zoster, Pain — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Severe pain from shingles although they have healed the pain is still there.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-30
Survey response — 3 months, dose 2MedDRA: Lymphadenopathy — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Swollen lymph nodes are backMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-06-15
- 2021-06-21
- 2021-06-24
- 2021-09-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-28 | Moderna | |
| 2 | 2021-02-26 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-09 | Unsuccessful | |
| 2021-03-27 | Unsuccessful | |
| 2021-04-04 | Unsuccessful |
Free text
Release 5 — day 7, dose 2
Systemic reaction (other): Shingles
Healthcare visit (other): Sensitive skin diagnosis shingles
Release 5 — day 14, dose 2
Symptoms: Pain in left side and swollen breast. Shingles have spread
Release 5 — day 21, dose 2
Symptoms: Left chest and under arm swelling and painful. Left side of stomach heavy or numb feeling. Painful to drive my car or hit bumps in road. Have to hold my left side to do anything
Release 6 — day 28, dose 2
Symptoms: Hospitalized for blood clots in leg and chest. Hospitalized given intravenously with blood thinners. Home with blood thinners, still having pain in chest and stomach area
Release 6 — day 35, dose 2
Symptoms: High fever 103, struggling to breathe, took to ER where they found 3 blood clots admitted to hospital (b)(6) Medical Center, put on blood thinners and oxygen
redacted (b)(6)
Release 7 — day 42, dose 2
Symptoms: Severe pain from shingles although they have healed the pain is still there.
Release 8 — 3 months, dose 2
Symptoms: Swollen lymph nodes are back
Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".
MedDRA terms by release
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | Herpes zoster | ✓ | ✓ | ✓ |
| HCVO | Sensitive skin | ✓ | ✓ | ✓ |
| SD | Abdominal discomfort | ✓ | ✓ | ✓ |
| SD | Abdominal pain | ✓ | ✓ | ✓ |
| SD | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Axillary pain | ✓ | ✓ | ✓ |
| SD | Breast swelling | ✓ | ✓ | ✓ |
| SD | Chest pain | ✓ | ✓ | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Flank pain | ✓ | ✓ | ✓ |
| SD | Herpes zoster | ✓ | ✓ | ✓ |
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Hypoaesthesia | ✓ | ✓ | ✓ |
| SD | Lymphadenopathy | ✓ | ✓ | ✓ |
| SD | Oedema peripheral | ✓ | ✓ | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Thrombosis | ✓ | ✓ | ✓ |
| SRO | Herpes zoster | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release